Innovations in allogeneic stem-cell transplantation

John F. DiPersio, Hanna Khoury, Jeff Haug, Ravi Vij, Douglas R. Adkins, L. Tim Goodnough, Randy A. Brown

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Allogeneic bone marrow transplantation (BMT) is associated with prolonged periods of neutropenia and thrombocytopenia, which can lead to severe infections and bleeding complications. Transplantation-related side effects might be ameliorated by use of cytokine-mobilized peripheral blood progenitor cells (PBPC) instead of bone marrow. We have studied PBPC mobilization and transplantation in more than 150 patients with high-risk hematologic malignancies. Normal donors can be sufficiently mobilized with granulocyte colony-stimulating factor (G-CSF), with 91% of G-CSF-stimulated normal donors producing more than 2 x 106 CD34+ cells/kg by a single apheresis. The combination of G-CSF plus granulocyte-macrophage colony- stimulating factor (GM-CSF) was more effective than mobilization with G-CSF alone. A clear relationship was seen between numbers of resting CD34+ cells premobilization and numbers of PBPC collected by apheresis, indicating that resting CD34+ cells might be used to predict mobilization results and identify donors who could benefit from more effective mobilization regimens. Transplantation of G-CSF-mobilized PBPC was associated with a more rapid engraftment than that observed for BMT. While engraftment was safe and acute graft-versus-host disease (aGvHD) rates were not increased over BMT, chronic GvHD rates were higher after PBPC transplantation. An additional PBPC infusion on day +3 resulted in a further shortening of neutropenia and thrombocytopenia. Incorporation of these innovative approaches with 'minimal' conditioning regimens has resulted in near-complete elimination of fever, neutropenia, thrombocytopenia, and the need for antibiotics and RBC and platelet transfusions after allogeneic transplantation. Copyright (C) 2000 by W.B. Saunders Company.

Original languageEnglish
Pages (from-to)33-41
Number of pages9
JournalSeminars in Hematology
Volume37
Issue number1 SUPPL. 2
DOIs
StatePublished - Jan 1 2000

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